A Perplexing CODE: Amniotic Fluid Embolism

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Roger Seheult, MD of MedCram explains amniotic fluid embolism. See all Dr. Seheult's videos at: www.medcram.com/
(This video was recorded on August 11th, 2023)
Roger Seheult, MD is the co-founder and lead professor at www.medcram.com/
He is Board Certified in Internal Medicine, Pulmonary Disease, Critical Care, and Sleep Medicine and an Associate Professor at the University of California, Riverside School of Medicine.
LINKS / REFERENCES:
Incidence and risk factors for amniotic-fluid embolism (Obstetrics and gynecology) | pubmed.ncbi.nlm.nih.gov/20410...
Amniotic Fluid Embolism (Cleveland Clinic) | my.clevelandclinic.org/health...
Atypical Amniotic Fluid Embolism Managed with a Novel Therapeutic Regimen (Hindawi) | www.hindawi.com/journals/crio...
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#embolism #pregnancy #childbirth

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29 июн 2024

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Комментарии : 65

@Medcram 10 месяцев назад

For more outstanding medical education videos that you need to know visit us at medcram.com. We offer continuing medical education units.

@JohnnyMotel99 10 месяцев назад

Hi Roger, Can you look at a possible link between RSP3E and long covid? I have two friends over 70 with sudden onset of RSP3E and both with serious covid infections.

@jodierwin4767 10 месяцев назад

I suffered and AFE /DIC almost 21 years ago. First pregnancy, 32 years old, healthy. On Sunday we celebrate my son’s 21st birthday. My husband is now a pulmonary/ critical physician in Dallas. He was in his residency at UTSW when we went through this. I’m thankful for physicians like you and my husband, who study this to help save the lives of women like me who experience these complications.

@Medcram 10 месяцев назад

That’s an amazing story. Honored to have you in our audience.

@daviddrake8742 10 месяцев назад

Great case, outstanding care and superb educational explanation.

@joephysics5469 10 месяцев назад

Thanks for uncovering one of my past nightmares. These days the anesthesia provider is the one who is the first critical care provider to care for these patients as I was back in the early 90's. My case was fortunately mild-ish without severe CV collapse. These were the days before echo, TXA and AOK. We probably gave steroids. We did start an art line and were ready to float a SWAN if things got worse. Multiple aggressive transfusions with frequent labs kept her stable enough. It all is something that is outside of what an OB has ever experienced so it is in your hands until you have an ICU doc to help out.

@Medcram 10 месяцев назад

Glad it turned out well!

@magsb3 10 месяцев назад

Amazing video with clear information on what to look for and what to do. Thank you for your quick response to save this patient.

@MyPerennial 10 месяцев назад

This is critical care at its finest, thank you so much for sharing this case and expanding knowledge to serve mankind.

@abdullatifalkhalid4983 9 месяцев назад

My wife had AFE 1 month ago. She had the same features you mentioned. She is 35 YO and the 1st baby for us. She was admitted for induction of labor and suddenly she collapsed and ventouse was apply for my daughter. Alhamdullah I’m very thankful for Allah then the doctors to recover her after 3 cycles of CPR and adrenaline injection. She had a massive bleeding and got 18 units of PRBC & 25 units of FFP. At that moment my life turned black in my eyes. At the moment Alhamdullah she’s doing well and getting better now. I’m so sorry for people who lost their families in AFE and I wish to find more info and studies in this situation. Hopefully find this video translated to Arabic.

@Medcram 9 месяцев назад

So happy your wife is doing well. You will both have a story to tell your daughter!

@canansahin82 9 месяцев назад

Very helpful video! For me as an OB&GYN I have seen one case during my residency and it was very similar scenario like your case Thanks to Allah ( GOD) she survived ❤

@bzat2024 8 месяцев назад

Fantastic job!! another life saved…….⭐️⭐️⭐️⭐️⭐️⭐️ She was lucky to give birth in a hospital with blood bank …or she would not have lived . Having delivered a couple thousand babies over my career , I am happy that my number NEVER came up for this catastrophic event …have treated pts with massive hemorrhage, shoulder dystocia, DIC , uterine rupture , eclampsia, etc but thankfully not AFE …. this is often SUDDEN , if UNdelivered , CPR very difficult , if not impossible with gravid uterus !!! Now you have TWO patients in trouble …….

@Medcram 8 месяцев назад

Yes, it’s our worst nightmare in critical care. Hearing your comment from a obstetrician has a lot of meaning for me. Thank you.

@bengielynjeminezcabauatanp3598 10 месяцев назад

thanks for the info God bless & family🙏🥰♥️🌷

@databoy2396 10 месяцев назад

Thank you for this wonderful resource!

@kcher 10 месяцев назад

Great review... thanks for presentation.

@yasmine4754 10 месяцев назад

Great case study. What a complicated scenario. So many things happening at the same time. Thank you, Dr. Seheult!

@Medcram 10 месяцев назад

Glad it was helpful!

@Mommaslew 10 месяцев назад

How can I be sure that if anything happens to me…that YOU ARE MY DOC?! You are brilliant.❤❤❤❤❤

@markgraham2312 10 месяцев назад

That was wonderful.

@krikeles 10 месяцев назад

The baby in the drawing is a footling breech!!!

@JenkinsSusan 10 месяцев назад

😅

@johnnyyu7439 10 месяцев назад

Very well explain even a pharma can follow. Thank you

@JayJay-sf2wn 10 месяцев назад

Damn! Nice work.

@rnw4468 10 месяцев назад

Wow this patient is very unfortunate-fortunate. Unfortunate cuz of AFE, fortunate cuz of the UAE plus massive blood products infusion. I came across the case back then we couldn’t get her back even by “resuscitative” hysterectomy and high quality of CPR on the table.

@TracyPerkins-dy7fm 7 месяцев назад

This is amazing that some people are so smart to study this to help people....this seems like this would be a nightmare to happen....this goes to show hiw dangerous a pregnancy can be.

@BruceNewhouse 10 месяцев назад

Impressive

@amby3805 10 месяцев назад

At what point in her care did you initiate the AOK protocol? Is it after getting labs back that confirmed the diagnosis? Or during initial resuscitation?

@amby3805 10 месяцев назад

Love the case -based teaching , by the way.

@Medcram 10 месяцев назад

It was at the beginning. Right after initial resuscitation.

@dawwnnyy2657 5 месяцев назад

I had one august 2022. Very tramatic situation. Not sure how i survived. AND i chose to not except blood because of my beliefs.

@helenfloersh7696 8 месяцев назад

Hi Dr. Seheult, this is an excellent video as always, thank you! I have a question if you're still checking comments: If this is mechanistically similar to anaphylaxis, is there a world where it makes sense to perform something like a skin prick test with amniotic fluid prior to birth to see if the patient is more likely to have a response? Or is it a different type of reaction? Have seen some research on biomarkers but it looks like the jury is mostly still out. Thank you!

@Medcram 8 месяцев назад

It’s very rare, so I don’t think they would do that. However, amniotic fluid in the bloodstream is always going to be unpredictable.

@ScottoGrotto 10 месяцев назад

Sorry for an off topic question Dr, but you have been my and others goto Covid update Dr! I’ve heard that hospitalizations are on the rise, what are the current Covid variants characteristics, risk levels, etc. We got Covid earlier this summer for the first time in Eastern Europe. It’s broken out a couple times this summer in my wife’s workplace here in SoCal. Thanks for any updates on this as usual 🙏✨🙏

@rogerseheult1312 10 месяцев назад

Video coming shortly

@ScottoGrotto 10 месяцев назад

@@rogerseheult1312 thank you so much Dr Seheult! Blessings ✨🙏✨

@Medcram 10 месяцев назад

It should be out by the end of the week. Basically we’re having another summer surge like we have in the past. But I don’t think it’s going to be as large this time. It could be related to people going indoors and air conditioning spreading it around. There’s no evidence that this new variant is worse or that it’s more infectious so far. Vaccination and boosters still afford protection for cases, hospitalizations and deaths.

@jeanettemorrell3693 8 месяцев назад

Hi, thanks for making these it's been helpful. Im curious if calcium was given?

@Medcram 8 месяцев назад

Yes. I often do when massive transfusions are given because of the dilution and citrate preservative in the pRBCs.

@user-wj6xb3np1c 10 месяцев назад

Meditech. Don’t Miss that EMR.

@mballer 10 месяцев назад

Do you look at what the patients health was prior to this happening so that perhaps the next patient could be helped to avoid it?

@flagmichael 10 месяцев назад

The NIH has a good list: "cerebrovascular disorders and cardiac disease have 25 fold and 70 fold higher risk of AFE, respectively. There is also a strong association of AFE with cesarean delivery, placenta previa, eclampsia, placental abruption, polyhydramnios, dilatation and curettage, and renal disease." It doesn't sound like many opportunities for prevention.

@mballer 10 месяцев назад

@@flagmichael You got 9 months to fix things. Is the cesarean delivery after this happens? Cesareans are also associated with low vitamin d levels. Are vitamin d levels low in these patients? Cardio vascular and brain issues are often related to high sugar intake, high insulin, even if prediabetic or diabetic, is this related here? When we back track to the root cause what do we find?

@Medcram 10 месяцев назад

Mildly elevated blood pressure was all. Not even in the preeclamptic range.

@Medcram 10 месяцев назад

There was really nothing to fix. Pretty healthy.

@mballer 10 месяцев назад

@@Medcram What is "pretty healthy"? Something wasn't working well. Was she on zero medications?

@brownhildasanto8856 10 месяцев назад

Great case!! What are the doses of atropine, Ondansetron and ketolorac used? And did you need to repeat doses? Pulm/CC here. Thank you

@Medcram 10 месяцев назад

Atropine 1mg Ondansetron 8mg Ketorolac 30mg IV We did not repeat the dose.

@brownhildasanto8856 10 месяцев назад

@@Medcram thank you

@yasmine4754 10 месяцев назад

This is a complex process. I'm not sure I understand why the emboli initially triggers the body to form all these clots (that use up fibrinogen).

@cacobarruvias5247 10 месяцев назад

Wife had AFE+DIC at age 24 when bring induced for our 4th child. They ended up removing her uterus... we had wanted a larger family 😢. I don't think Interventional Radiology was even considered.

@Medcram 10 месяцев назад

Sounds like she’s lucky to be alive

@FallingAsh 10 месяцев назад

I don’t think you realize how lucky you and your wife are that she survived and is still alive. I have seen a previously healthy woman with an uncomplicated pregnancy die from this leaving a newborn and her two other young children without a mother and a grieving husband without the love of his life.

@kellyfarrell4971 10 месяцев назад

Hi, I would love to hear your advice on getting a booster this year. Thanks.

@VICKVICKI 3 месяца назад

I am a survivor of A.F.E my Dr says he has ;not seen it in over 40 years So many young Dr's tell me oh I've seen it I say stop lying I still need help nO ONES UNDERSTAND omG please help me